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Content ArticleIntrahospital transport is a common occurrence for many hospitalised patients. Critically ill children are an especially vulnerable population who experience preventable adverse events at least once a week, on average. Transporting these patients throughout the hospital introduces additional hazards and increases the risk of adverse events. The transport process can be decomposed into a series of steps, each incurring specific risk. These risks are numerous and few of these risks are specific to the transport process. There is a paucity of literature available on paediatric intrahospital transport and related adverse events. Elliot et al. recently reviewed the Wake Up Safe database, a paediatric anesthesia quality improvement initiative across member institutions to disseminate information on best practices, for paediatric perioperative adverse events associated with anaesthesia-directed transport. The authors present several examples of airway and respiratory events taken from the database and discuss the complexity of the transport process.
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Content ArticleThe public health grant is paid to local authorities from the Department for Health and Social Care (DHSC) budget. It is used to provide vital preventative services that help to support health. This includes smoking cessation, drug and alcohol services, children's health services and sexual health services, as well as broader public health support across local authorities and the NHS.
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Content ArticleThe MindEd all-age eating disorders hub is aimed at all professionals, from universal to specialist. It contains key trusted evidence-based learning, curated and approved by an expert panel. The hub contains the following information:NHS policy guidanceProfessional bodies' guidanceProfessional associations' reportsCharitiesNHS learning and good practiceLegislation and reportsKey and influential textsUnder-served populations
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Content ArticleLittle information is available about the effect of childhood atopic dermatitis (AD) on family function. The aim of this study was to identify the areas of family life most affected and their perceived importance. Intensive qualitative interviews with 34 families were conducted and 11 basic problem areas were identified.
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Content ArticlePaediatric wards in acute hospitals are increasingly caring for children and young people (CYP) who have mental health needs. Paediatric wards are primarily designed to accommodate children with physical health needs and are not specifically designed to help keep children and young people with mental health needs safe. This national investigation looks at the risk factors associated with the design of paediatric wards in acute hospitals for children and young people with mental health needs.
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Content Article
The hardest question
Patient_Safety_Learning posted an article in Blogs
‘Mum… Do you think if I had a wheelchair, I could go into school sometime? Just for a while?’ There have been many lows since my son, Tarka, got Covid in January 2022 but that moment, 2 nights ago, was the moment that broke my heart. In this blog, Susanna Stanford talks about how Long Covid has left her 15 year old son incapacitated at times, with continued and worsening symptoms affecting his whole body as well as his ability to get on with his life. Susanna argues that the system is not set up to respond to either new symptoms or deterioration in Long Covid patients. -
Content ArticleThis national primary care clinical pathway for constipation in children guidance supports clinicians in the prevention and management of constipation in children and young people by providing a clear and standardised approach, based on guidelines from the National Institute for Health and Care Excellence (NICE), the British National Formulary for Children (BNFc) and clinical expert groups. The pathway promotes available resources for clinicians, families and other care providers and ensures they are easily accessible, as well as raises the profile of constipation in children and young people with a learning disability as a factor in adult mortality rates.
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Content Article
Attention deficit hyperactivity disorder (ADHD) is a condition that affects people's behaviour. It has a wide range of symptoms and can affect both children and adults—people with ADHD may find it hard to focus on or complete tasks, feel restless or impatient, experience impulsiveness and find it hard to organise their time and their things.[1] ADHD can have devastating mental health implications and research studies have linked ADHD to increased suicide and mortality rates. This means that being unable to access effective treatment can be a patient safety risk for people with ADHD. In this blog, Lotty Tizzard, Patient Safety Learning’s Content and Engagement Manager, explores the state of ADHD diagnosis and treatment in the UK. She looks at why many are concerned about the waiting times for adults and children seeking an ADHD assessment and speaks to Elsa*, who was diagnosed with ADHD in her 30s, about her experiences. *Name changed -
Content ArticleThe Covid-19 pandemic has shown the power and potential of vaccination in real time. But it has also disrupted health services and caused supply chain challenges, resulting in stagnation and backsliding of routine vaccinations. For example, global coverage of the third dose of the diphtheria–tetanus–pertussis vaccine fell from 86% in 2019 to 81% in 2021—the lowest level since 2008. 25 million children missed out on life-saving measles, diphtheria, and tetanus vaccines in 2021. This editorial in The Lancet calls for a catch-up to return to pre-pandemic vaccination levels and looks at how this can be achieved.
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News Article
England to offer Covid jab to five to 11-year-olds
Patient Safety Learning posted a news article in News
Children aged between five and 11 in England will be offered a low-dose Covid vaccine, the government says. Official scientific advice concludes the move would help protect the "very small" number of children who become seriously ill with Covid. Health Secretary Sajid Javid says the rollout will be "non-urgent", with an emphasis on parental choice. Northern Ireland also said on Wednesday it will be following Wales and Scotland in offering young children the vaccine. Children are at a much lower risk of becoming severely ill from a Covid infection, so the health benefits of vaccinating them are smaller than in other age-groups. Also, many will have some protection from already having caught the virus. So the scientists on the Joint Committee on Vaccination and Immunisation (JCVI), which advises governments across the UK, have been weighing up the evidence for immunising five to 11-year-olds. It concluded vaccination should go ahead to prevent a "very small number of children from serious illness and hospitalisation" in a future wave of Covid. Prof Wei Shen Lim, from the JCVI, said: "We're offering this to five to 11-year-olds now in order to future-proof their defences against a future wave of infection." He suggested parents consider getting their children vaccinated during school holidays to minimise disruption to their education from any flu-like side effects of the jab. Read full story Source: BBC News, 16 February 2022 -
News ArticleThe US Food and Drug Administration (FDA) is warning healthcare providers, parents and caregivers of pediatric patients (children) who receive enteral feeding that there is a risk of strangulation from the use of enteral feeding delivery sets. The feeding set tubing can become wrapped around a child’s neck and cause strangulation or death. The FDA has received reports of two toddlers who died after being strangled by the tubing. Recommendations for parents and caregivers of children who use enteral feeding delivery sets: Be aware that the feeding set tubing can get wrapped around a child’s neck, which can lead to strangulation or death. To the extent possible, avoid leaving the feeding set tubing where infants or children can become entangled. Discuss with your child's health care provider: If your child has been tangled in their tubing before. Steps you can take to help ensure that tubing does not get wrapped around your child’s neck, such as keeping the tubing away from the child as much as possible. Any other concerns you may have about the risk of strangulation from feeding set tubing. If your child is injured by feeding set tubing, please report the event to the FDA. Your report, along with information from other sources, can provide information that helps improve patient safety. Recommendations for healthcare providers: Review this topic and the information noted above with your colleagues, care teams, and caregivers of pediatric patients who use enteral feeding delivery sets, to ensure they are aware of the potential risk of strangulation with the associated tubing and are taking appropriate measures to keep the tubing away from the child as much as possible. When caring for pediatric patients who receive enteral feeding and as part of an individual risk assessment, be aware of the risk of strangulation from the feeding set tubing and follow protocols to monitor medical line safety. If a patient experiences an adverse event related to enteral feeding set tubing, you are encouraged to report the event to the FDA. Prompt reporting of adverse events can help the FDA identify and better understand the risks associated with medical devices. Read full story Source: FDA, 8 February 2022
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News Article
Only a third of children in need accessed mental health support in the pandemic
Patient Safety Learning posted a news article in News
The number of children experiencing mental health problems has risen sharply during the Covid-19 pandemic, but fewer have been able to access support because of disruptions to services, says a report by the Children’s Commissioner for England. Around one in nine children had a probable mental health disorder in 2017, the report says, but this jumped to one in six in 2021 with only around a third (32%) able to access treatment. While the number of children referred to mental health services by GPs and teachers has been growing in recent years, referral rates fell back in 2020-21 to 497 502 (equivalent to 4% of all children in England), compared with 539 000 (4.5% of children) the previous year. “It is likely that even though more children have mental health problems, fewer were being referred to services during lockdowns because of disruptions caused by the pandemic,” said children’s commissioner for England, Rachel de Souza. “Numbers referred into services are likely to increase again in the coming years. The health secretary will be publishing a review later this year to explore how we can tackle this increased level of need and adopt a more preventive approach.” Lynn Perry, interim co-chief executive of children’s charity Barnardo’s, said, “Covid-19 has taken a serious toll on children’s mental health and schools are the first place many of them seek help. Being able to reach this support early at school will reduce the number of children who need specialist help from mental health services. This is why Barnardo’s is calling on the government to speed up the rollout of mental health support teams to help pupils and teachers get the support they need, when they need it.” Read full story Source: BMJ, 7 February 2022 -
News ArticleChildren with mental health problems are dying because of failings in NHS treatment, coroners across England have said in what psychiatrists and campaigners have called “deeply concerning” findings. In the last five years coroners have issued reports to prevent future deaths in at least 14 cases in which under-18s have died while being treated by children’s and adolescent mental health services (CAMHS). The most common issues that arise are delays in treatment and a lack of support in helping patients transition to adult services when they turn 18. Coroners issue reports to prevent future deaths in extreme cases when it is decided that if changes are not made then another person could die. Dr Elaine Lockhart, the chair of the Royal College of Psychiatrists’ faculty of child and adolescent psychiatry, said the findings were “deeply concerning” and every death was a tragedy. She said there were too often lengthy delays and services were under strain as demand rises and the NHS faces workforce shortages. “In child and adolescent mental health services in England, 15% of consultant psychiatrist posts are vacant,” Lockhart said, calling for more support, investment and planning to grow staff levels. Read full story Source: The Guardian, 3 February 2022
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News ArticlePfizer and BioNTech said Tuesday that they were seeking emergency-use authorisation for the first coronavirus vaccine for children younger than 5 in the US and have begun submitting data on the safety and efficacy of the first two doses of a planned three-dose regimen. The Food and Drug Administration asked the companies to apply for authorization of their vaccine, and in an email, FDA spokeswoman Stephanie Caccomo said the omicron surge had generated new data “impacting the potential benefit-risk profile of a vaccine for the youngest children.” In December, Pfizer and BioNTech announced that the immune response generated by the vaccine in children between 2 and 4 years old was not sufficiently robust. But the companies said the vaccine had provoked a strong enough response in children 6 months to 2 years old. A third shot was added to the trial to increase the immune response. An earlier vaccine trial in children 5 to 11 years old was also focused on showing that those children had adequate immune responses after vaccination. In addition, there were enough cases of illness in that study population to determine that the vaccine was 91% effective in preventing symptomatic illness. The companies said Tuesday that the FDA requested they move forward with an application because of the “urgent public health need in this population,” noting that 1.6 million children under the age of 4 have tested positive for the coronavirus. “The need for a safe and effective vaccine for our youngest children is significant, particularly given the rapid spread of the omicron variant, the notable rise in the number of hospitalizations in young children with severe disease, and the possibility that future variants could cause severe disease in those who are unvaccinated,” Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said in a statement. Read full story Source: The Washington Post, 1 February 2022
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News ArticleThousands of children are falling through the cracks in youth addiction services owing to Covid, staff shortages and funding cuts, psychiatrists have said, as figures suggest the number able to get help has fallen to the lowest on record. Analysis of data from the National Drug Treatment Monitoring System (NDTMS) found that 11,013 under-18s were in treatment for drug and alcohol dependency in England in 2020-21, which was 3,278 fewer (23% less) than in 2019-20. It was the sharpest annual fall since records began, and means 13,481 fewer children were being treated than at a peak in 2008-09. The vast majority of children in treatment (89%, or 9,832) had a problem with cannabis and 41% (4,459) had a problem with alcohol. About 12% (1,333) were struggling with ecstasy use and 9% (976) reported a problem with powder cocaine. The Royal College of Psychiatrists, which analysed the data, said the pandemic, together with “drastic” historical funding cuts, was preventing young people from accessing the drug and alcohol treatment they need, potentially condemning them to a life of addiction. Dr Emily Finch, the vice-chair of the addictions faculty at the Royal College of Psychiatrists, said: “Children and their families up and down the country are having their lives blighted by drug and alcohol use due to drastic cuts, workforce shortages and the impact of the pandemic. “Addiction is a treatable health condition. Intervening early will mean many kids won’t go on to have an addiction in their adulthood, keeping them out of the criminal justice system and helping them to live full lives. It’s now time for the government to act on their promise and deliver the multimillion-pound investment into drug services.” Read full story Source: The Guardian, 3 February 2022
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News ArticleMore than 1 in 10 school entry-age children in England are at risk of measles because they have not had their vaccine jabs, data reveals. Coverage for the two doses of MMR that helps protect five-year-olds against measles, mumps and rubella is currently at 85.5%. That is the lowest for a decade, and well below the 95% target recommended to stop a resurgence of measles. Measles is highly contagious, more than Covid, and can cause serious illness. Nine in every 10 people can catch it if they are unjabbed and exposed. As well as a distinctive rash, measles can lead to severe complications, such as pneumonia and brain inflammation, and sometimes can be fatal. Vaccination can remove almost all of these risks. Two doses of the MMR vaccine give 99% protection against measles and rubella and about 88% protection against mumps. When a high percentage of the population is protected through vaccination, it becomes harder for the disease to pass between people. But since the start of the Covid pandemic, there has been a concerning drop in the number of children receiving these vaccines on time. Experts say some parents may not have realised doctors were still offering appointments, or did not want to burden the NHS. Coverage of the first dose of the MMR vaccine in two-year-olds has now fallen below 90%. This means that more than one in 10 children under the age of five are not fully protected from measles and are at risk of catching it. Among all five-year-olds in England, 93.7% have had one dose and 85.5% have had the recommended two doses. Read full story Source: BBC News, 1 February 2022
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News Article
Severe shortage of nurses in UK children’s intensive care units
Patient Safety Learning posted a news article in News
Britain’s sickest children are being treated in intensive care units that are struggling with severe shortages of the specialist nurses needed to look after them, a report says. The shortages in the UK’s 30 paediatric intensive care units (PICUs) are so severe that healthcare assistants are covering the work of nurses in an attempt to ensure that staffing levels are maintained. Only one of the PICUs – at the James Cook University hospital in Middlesbrough – was found to have enough nurses to guarantee the standards of care expected. About 15,000 children and young people a year, often with life-threatening conditions, are cared for in PICUs. Clinical standards that prevail in PICUs require them to ensure that seven nurses are on duty for each bed in a 24-hour cycle. However, the report by the Paediatric Intensive Care Audit Network (PICANet), a group of experts from Leicester and Leeds universities, found that 29 of the 30 had too few nurses to do that, and that all 30 had vacancies, sometimes large numbers of them. “Parents will find this extremely alarming”, said Patricia Marquis, the Royal College of Nursing’s England director. “Most people wouldn’t believe that only one paediatric intensive care unit across the whole UK has enough staff to function properly, but this is the reality of the workforce crisis. Key roles in specialist nursing teams are lying vacant for years.” Read full story Source: The Guardian, 23 January 2022 -
News ArticleHundreds of nurses, paramedics, health and care workers have been disciplined over allegations of sexual assault, including incidents involving child sexual abuse, The Independent can reveal. It comes as the government begins a year-long inquiry into the sexual abuse of dead patients by “morgue monster” David Fuller. Charities claim the true scale of the issue is likely to be hidden by “vast underreporting” while safeguarding experts say there is no “uniformity” in how NHS trusts handle such cases. The Health and Care Professions Council (HCPC), which regulates just under 300,000 workers including paramedics, occupational therapists, psychologists and physiotherapists, has taken action on 154 occasions following 293 investigations carried out into allegations of sexual assault or abuse since 2012, according to figures obtained by The Independent. Fifty-three clinicians were struck off, 20 were cautioned and a further 29 were either suspended, had restrictions placed on their practice or agreed to be removed from registration. More than half of the actions followed allegations of sexual abuse of a child patient. Separate data from Nursing and Midwifery Council (NMC), which has more than 700,000 registered nurses and midwives. shows action was taken 113 times in the past four years against nurses and midwives who did not maintain professional boundaries; in more than 80 per cent of those cases, the clinician was struck off. Read full story Source: The Independent, 21 January 2022
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News Article
Family of Cornwall girl, 6, misled over cause of death, coroner finds
Patient Safety Learning posted a news article in News
A six-year-old girl thought to have died from sepsis was in fact suffering from a blood condition triggered by E coli infection, an inquest has found. Coco Rose Bradford was taken to the Royal Cornwall hospital in the summer of 2017 suffering from stomach problems and later transferred to the Bristol Royal hospital for children, where she died. The following year an independent review flagged up failings in her care in Cornwall and the Royal Cornwall hospitals trust apologised for how it had treated her. Her family were left with the belief she had died of sepsis and could have been saved if she had been given antibiotics. But on Friday, coroner Andrew Cox, sitting in Truro, found that Coco died from multiple organ failure caused by haemolytic uraemic syndrome (HUS). The inquest heard there is no proven treatment for HUS. Cox said Coco’s family had been misled over the sepsis diagnosis, which he said was deeply regrettable, adding: “As a matter of fact, I find Coco had overwhelming HUS, not overwhelming sepsis.” During the inquest, the court heard Coco’s family felt staff at the Cornish hospital were “dismissive, rude and arrogant” and did not take her condition seriously. Cox found that although staff had recognised the risk of HUS from the moment Coco was admitted, this was not clearly set out in a robust management plan. The coroner also said a lack of communication had made Coco “something of a hostage to fortune”. Read full story Source: The Guardian, 14 January 2022 -
News Article
Rise in non-Covid virus that can leave children struggling to breathe
Patient Safety Learning posted a news article in News
Parents are being warned to look out for signs of a non-Covid virus that is “rife” in the UK amid a surge in reports of children struggling to breathe. The British Lung Foundation (BLF) said Respiratory Syncytial Virus (RSV) is staging a comeback this winter after lockdown last year meant there were fewer infections than would normally occur. It is concerned that this year children will have “much lower immunity” at a time when the NHS is already under extreme pressure. “In the last few weeks, we have noticed a surge in calls from parents who are worried about their child’s breathing,” said Caroline Fredericks, a respiratory nurse who supports the BLF’s helpline. “Most of these parents have never heard of RSV which is worrying.” RSV is common in babies and children. Almost all will have had it by the time they are two. It may cause a cough or cold but for some it can lead to bronchiolitis, an inflammatory infection of the lower airways which can make it hard to breathe. The early symptoms of bronchiolitis are similar to those of a common cold but can develop over a few days into a high temperature, a dry and persistent cough, difficulty feeding, and wheezing. While many cases clear up in two to three weeks, some children will end up being hospitalised. “There are steps parents can take to make their child more comfortable at home if their RSV develops into bronchiolitis, such as keeping their fluid intake up, helping them to breathe more easily by holding them upright when feeding and giving them paracetamol or ibuprofen suitable for infants,” said Fredericks. Read full story Source: The Guardian, 12 January 2022 -
News Article
NHS unable to treat every child with eating disorder as cases soar
Patient Safety Learning posted a news article in News
The NHS can no longer treat every child with an eating disorder, a leading psychiatrist has warned, as “worrying” figures reveal hospital admissions have risen 41% in a year. A dramatic surge in cases during the pandemic has left already struggling community services overstretched with many unable to care for everyone who requires help, experts said. NHS Digital data for England shows a sharp rise in admissions in every area of the country. The provisional data for April to October 2021 – the most recent available – shows there were 4,238 hospital admissions for children aged 17 and under, up 41% from 3,005 in the same period the year before. Charities said the fast rising number of hospital admissions was “only the tip of the iceberg”, with thousands more children needing support for eating disorders. Dr Agnes Ayton, the chair of the eating disorders faculty at the Royal College of Psychiatrists, said: “The hidden epidemic of eating disorders has surged during the pandemic, with many community services now overstretched and unable to treat the sheer number of people needing help. We are at the point where we cannot afford to let this go on any longer." “Early intervention is key to recovery and to preventing serious illness, which is why it’s crucial that the money announced by government urgently reaches the frontline. The government must also deliver a workforce plan to tackle the shortages in eating disorder services so that they have enough staff to treat everyone who needs help.” Read full story Source: The Guardian, 4 January 2021 -
News ArticleMore than 167,000 children are believed to have lost parents or caregivers to Covid during the pandemic – roughly one in every 450 young people in the US under age 18. The count updates the October estimate that 140,000 minors had lost caregiving adults to the virus, and is four times more than a springtime tally that found nearly 40,000 children had experienced such loss. In a report titled Hidden Pain, researchers from the COVID Collaborative and Social Policy Analytics published the new total, which they derived by combining coronavirus death numbers with household-level data from the 2019 American Community Survey. The death toll further underscores the daunting task facing schools as they seek to help students recover not just academically, but also emotionally, from a pandemic that has already stretched 22 months and claimed more than 800,000 American lives. It’s an issue of such elevated concern that Surgeon General Vivek Murthy, on 7 December, used a rare public address to warn Americans of the pandemic’s “devastating” effects on youth mental health. An accompanying 53-page report calls out the particular difficulties experienced by young people who have lost parents or caregivers to the virus. Bereaved children have higher rates of depression and post-traumatic stress disorder than those who have not lost parents, according to a 2018 study that followed grieving children for multiple years. They are more than twice as likely to show impairments in functioning at school and at home, even seven years later, meaning these children need both immediate and long-term counseling and support to deal with such a traumatic loss. “For these children, their whole sky has fallen, and supporting them through this trauma must be a top priority.” Read full story Source: The Guardian, 22 December 2021
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News ArticleThree pharmacy and medication safety organisations are warning clinicians about a reported increase in age-related COVID-19 vaccine mix-ups. The Institute for Safe Medication Practice's National Vaccine Errors Reporting Program said it's seen a "steady stream" of mix-ups involving the Pfizer vaccine intended for kids ages 5-11 and formulations for people 12 and older. ISMP said the reports involved hundreds of children and included young children receiving formulations meant for those 12 and up or vice versa. The safety organisation said some errors were linked to vial or syringe mix-ups. In other situations, healthcare providers gave young children a smaller or diluted dose of the formulation meant for people 12 and up. "Vaccine vials formulated for individuals 12 and up (purple cap) should never be used to prepare doses for the younger age group," the organisation said. Read full story Source: Becker's Hospital Review, 7 December 2021
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News ArticleNearly 2,000 children and teenagers have been left waiting for specialist mental health care for at least a year in Scotland, according to official figures branded “damning” by psychiatrists. New NHS Scotland data has revealed that, at the end of September, there were 1,978 patients who had been waiting 52 weeks or more for a Child and Adolescent Mental Health Services (CAMHS) appointment. That is more than double the 959 young people who were waiting that long the previous September – despite efforts by Nicola Sturgeon’s government to meet its own 2023 target for 90% of young people to receive help within 18 weeks. Ahead of the Holyrood Budget on Thursday, the figures prompted calls from service providers for a “radical transformation of our mental health services” enacted with the same zeal as the response to the coronavirus pandemic and with a focus on earlier interventions to prevent young people “giving up on their futures”. According to the latest figures, there were a total of 11,816 young people waiting for an appointment by the end of September – just 78% of them who had been seen within 18 weeks. Dr Helen Smith, chair of the CAMHS faculty of the Royal College of Psychiatrists in Scotland, said the long waits for help highlighted the “many problems” with these services “across the length and breadth of the country”. “The fact that our vulnerable children and young people are still waiting to be seen is, frankly, not good enough,” Dr Smith said. “We need them to be able to access the right support at the right time, from the correct services.” Read full story Source: The Independent, 8 December 2021
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News Article
Poorly controlled asthma 'increases Covid risk for children'
Patient Safety Learning posted a news article in News
Children with poorly controlled asthma are up to six times more likely to be admitted to hospital with Covid than those without the condition, research has suggested. Scientists involved in the study said 5 to 17-year-olds in this category should be considered a priority for Covid vaccination. About 9,000 children in Scotland would benefit from the jab, researchers said. Vaccines are offered to the over-12s in Scotland, but not to younger children. In the study, poorly controlled asthma was defined as a prior hospital admission for the condition, or being prescribed at least two courses of oral steroids in the last two years. Prof Aziz Sheikh, director of the University of Edinburgh's Usher Institute and Eave II study lead, said: "Our national analysis has found that children with poorly controlled asthma are at much higher risk of Covid-19 hospitalisation. "Children with poorly controlled asthma should therefore be considered a priority for COVID-19 vaccination alongside other high-risk children." Prof Sheikh said it was important to consider both the "risks and benefits" from vaccinations. He added: "Emerging evidence from children aged five and older suggests that COVID-19 vaccines are overall well-tolerated by the vast majority of children." Read full story Source: BBC News, 1 December 2021
